Mechanisms of glomerular hyperfiltration in diabetes mellitus
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- David M Nathan, MD
David M Nathan, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Diabetes Mellitus
- Professor of Medicine
- Harvard Medical School
A 25 to 50 percent elevation in the glomerular filtration rate (GFR) is seen early in the course in up to one-half of patients with type 1 diabetes mellitus , an abnormality that is exaggerated after ingestion of a protein load . Glomerular hypertrophy and increased renal size typically accompany the rise in GFR .
Hyperfiltration also occurs early in the course of type 1 and type 2 diabetes [3,4]. In an original report of 110 newly diagnosed patients with type 2 diabetes mellitus, for example, the GFR was above 140 mL/min in 16 percent and more than two standard deviations above the mean of a control population in 45 percent . The prevalence of hyperfiltration may be lower in the era of more aggressive glucose control. A later study of 93 newly diagnosed patients, for example, found that 17 percent had a GFR that was more than two standard deviations above the mean of a control population .
The degree of hyperfiltration and the course of the GFR in type 2 diabetes mellitus was evaluated in more detail in a study of 194 Pima Indians who had GFR measured using iothalamate clearance . The following results were noted:
●In 31 patients with a normal glucose tolerance test, the mean GFR was 123 mL/min.
●In 29 patients with impaired glucose tolerance, the mean GFR was 135 mL/min.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Bank N. Mechanisms of diabetic hyperfiltration. Kidney Int 1991; 40:792.
- Tuttle KR, Bruton JL, Perusek MC, et al. Effect of strict glycemic control on renal hemodynamic response to amino acids and renal enlargement in insulin-dependent diabetes mellitus. N Engl J Med 1991; 324:1626.
- Vora JP, Dolben J, Dean JD, et al. Renal hemodynamics in newly presenting non-insulin dependent diabetes mellitus. Kidney Int 1992; 41:829.
- Nelson RG, Bennett PH, Beck GJ, et al. Development and progression of renal disease in Pima Indians with non-insulin-dependent diabetes mellitus. Diabetic Renal Disease Study Group. N Engl J Med 1996; 335:1636.
- Jin Y, Moriya T, Tanaka K, et al. Glomerular hyperfiltration in non-proteinuric and non-hypertensive Japanese type 2 diabetic patients. Diabetes Res Clin Pract 2006; 71:264.
- Bakris GL, Slataper R, Vicknair N, Sadler R. ACE inhibitor mediated reductions in renal size and microalbuminuria in normotensive, diabetic subjects. J Diabetes Complications 1994; 8:2.
- Serri O, Beauregard H, Brazeau P, et al. Somatostatin analogue, octreotide, reduces increased glomerular filtration rate and kidney size in insulin-dependent diabetes. JAMA 1991; 265:888.
- Hirschberg R, Brunori G, Kopple JD, Guler HP. Effects of insulin-like growth factor I on renal function in normal men. Kidney Int 1993; 43:387.
- Hirschberg R, Kopple JD. The growth hormone-insulin-like growth factor I axis and renal glomerular function. J Am Soc Nephrol 1992; 2:1417.
- Anderson S, Vora JP. Current concepts of renal hemodynamics in diabetes. J Diabetes Complications 1995; 9:304.
- Vervoort G, Veldman B, Berden JH, et al. Glomerular hyperfiltration in type 1 diabetes mellitus results from primary changes in proximal tubular sodium handling without changes in volume expansion. Eur J Clin Invest 2005; 35:330.
- Cherney DZ, Sochett EB, Miller JA. Gender differences in renal responses to hyperglycemia and angiotensin-converting enzyme inhibition in diabetes. Kidney Int 2005; 68:1722.
- Passariello N, Sepe J, Marrazzo G, et al. Effect of aldose reductase inhibitor (tolrestat) on urinary albumin excretion rate and glomerular filtration rate in IDDM subjects with nephropathy. Diabetes Care 1993; 16:789.
- Vlassara H. Protein glycation in the kidney: role in diabetes and aging. Kidney Int 1996; 49:1795.
- Sabbatini M, Sansone G, Uccello F, et al. Early glycosylation products induce glomerular hyperfiltration in normal rats. Kidney Int 1992; 42:875.
- Vallon V, Blantz RC, Thomson S. Glomerular hyperfiltration and the salt paradox in early [corrected] type 1 diabetes mellitus: a tubulo-centric view. J Am Soc Nephrol 2003; 14:530.
- Hannedouche TP, Delgado AG, Gnionsahe DA, et al. Renal hemodynamics and segmental tubular reabsorption in early type 1 diabetes. Kidney Int 1990; 37:1126.
- Vallon V, Richter K, Blantz RC, et al. Glomerular hyperfiltration in experimental diabetes mellitus: potential role of tubular reabsorption. J Am Soc Nephrol 1999; 10:2569.
- Skrtić M, Yang GK, Perkins BA, et al. Characterisation of glomerular haemodynamic responses to SGLT2 inhibition in patients with type 1 diabetes and renal hyperfiltration. Diabetologia 2014; 57:2599.
- Cherney DZ, Perkins BA, Soleymanlou N, et al. Renal hemodynamic effect of sodium-glucose cotransporter 2 inhibition in patients with type 1 diabetes mellitus. Circulation 2014; 129:587.
- Thomas MC. Renal effects of dapagliflozin in patients with type 2 diabetes. Ther Adv Endocrinol Metab 2014; 5:53.